잠시만 기다려 주세요. 로딩중입니다.

Perspective of the comparative effectiveness of non-pharmacologic managements on postpartum hemorrhage using a network meta-analysis

Obstetrics & Gynecology Science 2020년 63권 5호 p.605 ~ 614
이경주, 홍관, 황하리, 최희정, 손상호,
소속 상세정보
이경주 ( Lee Kyung-Ju ) - Korea University Graduate School Department of Public Health
홍관 ( Hong Kwan ) - Korea University College of Medicine Department of Preventive Medicine
황하리 ( Hwang Ha-Ri ) - Korea University Graduate School Department of Public Health
최희정 ( Choi Hi-Jeong ) - CHA University Graduate School of Integrative Medicine
손상호 ( Sohn Sang-Ho ) - Korea University Graduate School Department of Public Health

Abstract


Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review’s objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates

Methods: We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison.

Results: We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50-30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22-2.50).

Conclusion: For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.

키워드

Postpartum hemorrhage; Balloon tamponade; Uterine artery embolization; Network meta-analysis

원문 및 링크아웃 정보

등재저널 정보